Community Fund Application - Facility Hires

Organisation

Organisation Name

Organisation Status
Are you a community group/trust/incorporated society/ company/ other?

Contact person

Contact person name
 

Contact person email
 

Contact person phone number

About your facility hire

Proposed facility
Lincoln Event Centre, Rolleston Community Centre, etc.

Purpose of proposed bookings?
What activities will you be running?

Are there any user costs associated with your project/event/initiative? If so, what are these costs and how much are they?
i.e. $30 per term for membership.

Estimated total number of people benefiting from this project/event/initiative

Please specify the proposed time/frequency of bookings
i.e. Every Tuesday from 7:00pm - 8:00pm in October and November

Please state the venue charge rate
Amount ($)

Please state how much you are applying to the Selwyn Community Fund for (GST exclusive).
Amount ($)

Are you also applying to the Selwyn Community Fund for other funding?
i.e. Event costs

Please attach a copy of your annual budget and/or your latest audited accounts.
Files must be Word or PDF format and no larger than 5mb

Declaration

I hereby declare that the above information is correct. If the application is successful, my organisation agrees to provide within one month after the project/initiative/event has taken place:

1. A full report on the project/initiative/event (report template provided)
2. No less than two high resolution (minimum 1MB, jpeg format) photos from the event, video will also be accepted. The text and photos can be shared through Selwyn District Council media channels including but not limited to Council website, social media, newspaper publications, etc. to promote the positive outcomes that come from the Community Funding Scheme.
3. An accountability report within 12 months of receiving funding or as soon as the funds are spent (template provided on success)
4. Any Selwyn Community Fund grant funding not spent on the project for which the funds were applied for, after one year of receiving the funds, must be returned to Council unless written approval to retain the funds is obtained.

• I accept the conditions and am authorised to create this authority

Applicant Details

If you require remittance advice please check the box below

• I do need remittance advice

Remittances can be forwarded to you via email. Please supply your email address if you have checked the above box.
 

Bank account number
Please write your 15 digit bank account number below

Please attach a proof of bank account otherwise no payments can be made
Files must be Word or PDF format and no larger than 5mb

Authorised by
Insert name

Date